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Hypertensive Encephalopathy Triggered by Indomethacin Use
Jane Plitman1, Vanessa Raco2, Peter E Wu1,3
1Department of Medicine University of Toronto Toronto Canada.
Clinical Case Reports
|November 21, 2024
Summary
Indomethacin, a non-steroidal anti-inflammatory drug (NSAID), can trigger hypertensive encephalopathy in older adults with high blood pressure. Discontinuing the NSAID and managing hypertension resolved the patient's confusion and headaches.
Area of Science:
- Neurology
- Cardiology
- Pharmacology
Background:
- Hypertensive encephalopathy is a neurological condition characterized by acute confusion and elevated blood pressure.
- Non-steroidal anti-inflammatory drugs (NSAIDs) can exacerbate underlying hypertension, particularly in elderly patients.
- The renin-angiotensin-aldosterone (RAS) system plays a crucial role in blood pressure regulation, and its inhibition can increase susceptibility to NSAID-induced complications.
Purpose of the Study:
- To report a case of hypertensive encephalopathy triggered by indomethacin in an elderly male patient.
- To highlight the potential risks of NSAID use in patients with uncontrolled hypertension and those on RAS-inhibiting medications.
- To emphasize the importance of careful patient evaluation before prescribing NSAIDs.
Main Methods:
- Case report of a male patient in his 70s presenting with acute confusion.
- Review of patient's medical history, including recent indomethacin prescription and existing hypertension treated with trandolapril.
- Clinical examination, laboratory tests, and neuroimaging (CT and MRI) to rule out other causes.
- Discontinuation of indomethacin and management of hypertension with amlodipine.
Main Results:
- The patient presented with severe hypertension (190/110 mmHg) and acute confusion.
- Laboratory and imaging studies were unremarkable for acute neurological processes or infections.
- Following indomethacin discontinuation and blood pressure normalization, the patient's confusion and headaches resolved.
- The patient was diagnosed with indomethacin-induced hypertensive encephalopathy.
Conclusions:
- NSAID use, including indomethacin, can precipitate hypertensive encephalopathy, especially in patients with pre-existing hypertension.
- Patients on anti-hypertensive medications that inhibit the RAS system are at higher risk for NSAID-related blood pressure decompensation.
- Clinicians must carefully weigh the benefits against the risks of NSAIDs, considering the patient's overall health status and medication regimen.
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